Organization
WELLQOR PSYCHOLOGICAL SERVICES NORTHEAST, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER VIETZE PHD (OWNER)
(347) 668-4992
Entity
Organization
Contact information
Practice address
1001 RARITAN AVE, HIGHLAND PARK, NJ 08904-3667
(732) 991-1540
Mailing address
135 PINELAWN RD STE 204N, MELVILLE, NY 11747-3133
(516) 987-4200
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017065
PROFESSIONAL LICENSE
NY
01
—
35SI00517600
PROFESSIONAL LICENSE
NJ
Enumeration date
10/17/2014
Last updated
06/08/2020
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